Examining the psychological impact of expectant management of early pregnancy loss on women’s well-being: a systematic review

Background: Early pregnancy loss can be a distressing time when women may encounter negative psychological experiences. Expectant management of early pregnancy loss can lead to negative psychological outcomes which require treatment. 

Research question: What are the psychological impacts of expectant management for women experiencing early pregnancy loss and the approaches to support maternal wellbeing?

Search methods: A systematic review of the literature was conducted in December 2020 to assess the psychological impact of expectant management of early pregnancy loss and approaches that support maternal wellbeing. A search of CINAHL, PsycInfo, ASSIA, PubMed and MEDLINE returned 12,360 studies; 36 studies were eligible for full-text screening after duplicate removal and title and abstract screening. Five eligible studies for review were included (two randomised controlled trials (RCTs) and three qualitative studies) and are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

Results: A total of 326 participants, aged 18–45 years, who received treatment for early pregnancy loss were sampled across all included studies. Findings are presented under three themes: the impact of expectant management on psychological wellbeing; the provision of care and the provision of information. Expectant management is associated with a longer duration of bleeding and delayed return to daily activities. Women who undergo expectant management for early pregnancy loss can experience higher rates of anxiety and depression. The provision of quality information to those undergoing expectant management may help to reduce fears and anxieties about treatment.

Conclusion: Women who opt for expectant management may encounter negative psychological impacts during and after intervention. Without support and essential follow up, the mental wellbeing of this population may be at risk of deterioration. Health care professionals caring for women experiencing early pregnancy loss should ensure comprehensive enquiry is made about the mental wellbeing of women who have undergone expectant management and offer follow-up appointments to monitor for deterioration.